An efficient heuristic for the multi-vehicle one-to-one pickup and delivery problem with split loads

In this study, we consider the Multi-vehicle One-to-one Pickup and Delivery Problem with Split Loads (MPDPSL). This problem is a generalization of the one-to-one Pickup and Delivery Problem (PDP) where each load can be served by multiple vehicles as well as multiple stops by the same vehicle. In practice, split deliveries is a viable option in many settings where the load can be physically split, such as courier services of third party logistics operators. We propose an efficient heuristic that combines the strengths of Tabu Search and Simulated Annealing for the solution of MPDPSL. Results from experiments on two problems sets in the literature indicate that the heuristic is capable of producing good quality solutions in reasonable time. The experiments also demonstrate that up to 33\% savings can be obtained by allowing split loads; however, the magnitude of savings is dependent largely on the spatial distribution of the pickup and delivery points

Sudden, Painless Incontinence following Extracorporeal Shock Wave Lithotripsy: A Case Report

Urinary incontinence is a stent-related complication; however, total incontinence is not often seen in emergency departments. We report a patient who presented with a sudden, painless, and total urinary incontinence after extracorporeal shock wave lithotripsy. This is the first case of total incontinence due to migrated ureteral double J stent through the external urethral sphincter into the urethra following extracorporeal shock wave lithotripsy

Persistent Left Superior Vena Cava and Partial Anomalous Pulmonary Venous Return in an Old Asymptomatic Female Patient

Persistent left superior vena cava is a rare congenital venous anomaly. It results from failure of closure of the left anterior cardinal vein during cardiac development. It is usually asymptomatic but can be associated with other congenital cardiac defects including atrial septal defects, ventricular septal defects, endocardial cushion defects, tetralogy of Fallot and rhythm disturbances. PLSVC should be considered in the presence of a dilated coronary sinus on transthoracic echocardiography. The diagnosis can be made when injection of contrast in left antecubital vein results in enhancement of the dilated coronary sinus before right atrium. MRI, CT-scan and catheterisation can be used to confirm the diagnosis

Primary Adrenal Failure due to Antiphospholipid Syndrome

Background. Antiphospholipid syndrome (APS) characterized by thrombosis and abortus may rarely cause primary adrenal failure. Case Presentations. A 34-year-old male presented with hypotension, hypoglycemia, hyperpigmentation on his skin and oral mucosa, scars on both legs, and loss of consciousness. In laboratory examinations, hyponatremia (135 mmol/L), hyperpotassemia (6 mmol/L), and thrombocytopenia (83 K/µL) were determined. Cortisol (1.91 µg/dL) and adrenocorticotropic (550 pg/mL) hormone levels were also evaluated. The patient was hospitalized with a diagnosis of acute adrenal crisis due to primary adrenal insufficiency. A Doppler ultrasound revealed venous thrombosis. The patient was diagnosed with antiphospholipid syndrome after the detection of venous thrombosis, thrombocytopenia, elevated aPTT, and anticardiolipin antibody levels. Anticoagulation treatment was started for antiphospholipid syndrome. The patient is now following up with hydrocortisone, fludrocortisone, and warfarin sodium. Conclusion. Antiphospholipid syndrome is a rare reason for adrenal failure. Antiphospholipid syndrome should be suspected if patients have morbidity secondary to venous-arterial thrombosis

Riskli gebelerin doğum korkusu, emzirme özyeterlilik ve emzirme başarılarının belirlenmesi

Amaç: Bu çalışmada, yüksek riskli gebelerin doğum korkusu, emzirme özyeterlilik ve emzirme başarısı arasındaki ilişkinin değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Kesitsel ve tanımlayıcı tipte yapılan çalışma Ankara’da bir eğitim araştırma hastanesinde Ocak-Kasım 2017 tarihleri arasında perinatoloji servisine doğum amaçlı yatan gebelere uygulanmıştır. 326 gebe ile çalışma tamamlanmıştır. Çalışmaya katılan tüm gebelerden yazılı ve sözlü onam alındıktan sonra, anket form (sosyo demografik, obstetrik, geçmiş emzirme deneyimi ve doğum eylemi süreciyle ilgili özellikler) yüzyüze doldurulmuştur. Doğum Korkusu Ölçeği (DKÖ), servikal dilatasyon 3cm (DKÖ-1), 6 cm (DKÖ-2) ve 9 cm iken (DKÖ-3), Emzirme Öz-Yeterlilik Ölçeği (EÖYÖ) ve Latch Emzirmeyi Değerlendirme ve Tanılama Ölçeği (LATCH) kullanılmıştır. Bulgular: Çalışmaya katılan tüm gebelerde DKÖ puan ortalaması 37,92±6,87 olarak bulunmuştur. Herhangi bir işte çalışmayan, geliri giderinden düşük olan, kronik bir rahatsızlığı olan gebelerde DKÖ puan ortalaması daha yüksek bulunmuştur (p<0,05). Çalışmada DKÖ-1 puan ortalaması 43,40±8,28, DKÖ-2 puan ortalaması 37,49±7,89, DKÖ-3 puan ortalaması 32,87±8,69 olarak tesbit edilmiştir. Ölçümler arasında farkın istatistiksel olarak anlamlı olduğu bulunmuştur (p<0,001). Çalışmada DKÖ puan ortalaması ile EÖYÖ puan ortalaması arasında istatistiksel olarak anlamlı bir ilişkinin olmadığı (p=0,199, r=-0,071), LATCH puan ortalaması ile pozitif yönlü ilişkisinin olduğu (p<0,001, r=0,229) saptanmıştır. Sonuç: Yüksek düzeyde doğum korkusu yaşayan annelerin emzirme başarılarının daha düşük olduğu tesbit edilmiştir. Bu kapsamda, doğum öncesi dönemde gebelerin doğuma hazırlık eğitimine katılarak; gebelik, doğum, postpartum dönem ve emzirme konularında destek alması önerilmektedir

Diagnostic performance and interobserver agreement of CO-RADS: evaluation of classification in radiology practice

PURPOSEWe aimed to evaluate the use of the COVID-19 reporting and data system (CO-RADS) among radiologists and the diagnostic performance of this system.METHODSFour radiologists retrospectively evaluated the chest CT examinations of 178 patients. The study included 143 patients with positive reverse transcriptase-polymerase chain reaction (RT-PCR) test results and 35 patients whose RT-PCR tests were negative but whose clinical and/or radiological findings were consistent with COVID-19. Fleiss’ kappa (κ) values were calculated, and individual observers’ scores were compared. To investigate diagnostic efficiency, receiver operating characteristic (ROC) curves were calculated for each interpreter.RESULTSThe interpreters were in full agreement on 574 of 712 (80.6%) evaluations. The common Fleiss’ κ value of all the radiologists combined was 0.712 (95% confidence interval [CI] 0.692–0.769). A reliable prediction on the basis of RT-PCR and clinical findings indicated the mean area under the curve (AUC) of Fleiss’ κ value as 0.89 (95% CI 0.708–0.990). General interpreter agreement was found to range from moderate to good.CONCLUSIONThe interpreter agreement for CO-RADS categories 1 and 5 was reasonably good. We conclude that this scoring system will make a valuable contribution to efforts in COVID-19 diagnosis. CO-RADS can also be of significant value for the diagnosis and treatment of the disease in cases with false-negative PCR results